How did you first find out about bariatric surgery and what were your initial impressions of it?

As a nurse, I knew about the surgery for many years. A student of mine had it a few years ago and we e-mailed back and forth. She eventually became a bariatric nurse practitioner. Because of her results and my research - I went into the bariatric research and decided that it had enough of a history to take a chance on. I knew the risks going in. Originally I thought of it as similar to wiring jaws shut - an extreme measure with too many risks. Last year I saw it as my only option - I could either have a stroke or a heart attack from my obesity or I could die during or after RNY surgery. I knew that if I chose the band - I would find ways to eat through straws and eventually have the band removed. I knew that I would never control the weight gain associated with any future weight reduction plan/diet - just more weight and more risk - because I firmly believe that there is a strong evolutionary genetic mechanisms for many obese people- we come from an early species of man - Neanderthal - who had to survive long winters and needed the ability to hold onto fat for the lean times. It was a survival mechanism in our genes. Psychology plays a part in the life of my obesity - but if psychology was the main reason for being fat - then I should have wanted to eat months ago - and I had no interest for 8 months.

Describe your experience with getting insurance approval for surgery. What advice, if any, do you have for other people in this stage?

I was lucky. I had an excellent medical record of my obesity history. The insurance company denied me one month before surgery. I just had my primary physician send them another copy of the records and they approved within a week of my scheduled surgery. I saw others get denied and could feel their absolute devastation. I knew that if I was told the night before surgery that I had to wait and do weight programs for another year - I would consider suicide as another option. bariatric surgery was a crisis decision for me - there was no room for dumb insurance hold ups. I just got lucky because I kept great medical records on myself since I was a nurse - it had nothing to do with preparing for the RNY - I had them in detail because I wanted to be healthy and had tried other things - all my life.

What was your first visit with your surgeon like? How can people get the most out of this meeting?

My surgeon mandated that you had to go to the informational sessions on both the RNY and the band. His presentation was to an audience of those thinking of surgery and those who had had it - so that he and his support team could introduce the group to the "whole package" - pre and post op planning and counseling. He presented the history of the surgery, the statistics over the past 50 years, and then his own statistics. I'm a researcher and that impressed me. i did my own research after that meeting and saw that his resources were absolutely accurate. He gave risks and benefits - and what was still unknown - especially nutritional problems for years after the surgery. I checked his credentials and medical history through a search engine that cost $10 to examine any law suits against physicians and what his specialty areas were. He had more than 200 surgeries done - lap - and no deaths. he told us about the complictions he did have and how they were taken care of. He was not that "friendly" when we met over the next few months - preparing for the surgery - going through all the medical evaluations - he was detailed and crisp in getting and giving information. His staff were the "warm and fuzzy" part of his practice. I decided to ask him to look me in the eyes when talking to me and make him pay attention to my researcher comments and questions. He respected my knowledge base and was comfortable talking research with me related to the surgery. I chose him because he was an expert surgeon with good results - and a caring team. he did not have to make me feel warm and fuzzy - I had friends and family who could do that for me. And his team did a great job too.

What made you finally decide to have the surgery?

Dangerously high blood pressures and just overall misery with my health and well being

How did you decide which proceedure to have?

I attended both informational meetings. At first I was going to have the band - I saw it was less invasive and extreme. But after researching the procedure and saw the exchanges on web sites - I realized that the band would not work for me. The stomach would still be there and I believed that there was a physiological trigger in the stomach that added to the cravings - only doing the RNY (based on best statistics for that procedure) convinced me to do the RNY - I felt I would be able to deal with the nutritional outcomes - using vitamins and supplements - and nutritional advice.

What fears did you have about having complications or even dying from from the surgery, and what would you tell other people having the same fears now?

As a nurse - death is part of my professional experience. People die for many reasons - often unexpected. We can die at any moment from some unknown genetic problem that was never diagnosed at birth - or from a sudden aneurysm - by walking across the street (hit and run) or by any traumatic means. Life is not guaranteed - I knew all of the risks and benefits - the scale tipped towards surgery and not continuing at my weight of 290 or more. My partner was more impacted by the fear of losing me - and that has continued to be a problem a year later. The fears of the post-op long term nutritional problems can still be a problem.

How did your family and friends react to your decision? Would you have communicated anything differently if you could now? How supportive were they after your surgery?

My partner felt I had "not discussed the surgery" - that it was not a family decision. Even though I was being 'worked up' for 9 months - and not once during that time did they say - "don't do it". My perception was that they were part of the decision and the planning. Immediately after the surgery - my partner stopped a nurse from making a potentially fatal error - the RN was about to clear my IV line with 10 cc of air and not sterile saline. That precipitated into a difficult year of anger and outbursts on my partner's part. Fear of death, fear of problems (and I did have a number of them ) and fear of long term nutritional problems (a possibility) - there was the social loss of "eating together" - it was seen as "not fun anymore" to go out with me - I didn't prepare meals for almost 6 months - because of extreme aversion to almost all foods and smells. The family problems have only escalated a year later - it took a long time to get my partner to agree to therapy. We are in individual and couples therapy now - going slowly and with immense difficulty.

How did your employer/supervisor react to your decision? What did you tell him/her? How long were you out of work?

I did not inform my Dean or my nursing colleagues until the surgical date was certain. Then I did tell everyone. They were extremely supportive - came to the hospital - sent cards through the summer - and continue to support me a year later - They watched dramatic changes. I had the surgery at the beginning of the summer - and was 100 lbs less at the beginning of the next semester - I was told by the Dean that some of the administrators thought I had cancer. They were reassured and since then have responded very positively to the changes. Most significant has been the reaction that I am taken more seriously at committee meetings. Really!

What was your stay in the hospital like? How long where you there? What things are most important to bring?

The pre-op admission routine was excellent. I was well-prepared by both the pre-op nurses and the anesthesia department. My partner was informed periodically of how the surgery was going and the surgeon spoke with them immediately after and each day during my recovery. The floor was a special bariatric floor with nurses that were "educated about bariatric recovery" - most of them were excellent - several were inappropriate. They were understaffed and there were too many patients per nurse - this made all of the medications arrive late - and they could not stay on top of any type of non-medication care - like responding to bathroom needs etc. Care aids were not as well trained in caring for bariatric patients and tended to treat us as "deserving of the pain" as I overheard one night. My pain was never under control during the 5 days of my stay. Since I had sleep apnea the surgeon did not order the morphine pump and insisted that I take Demerol by injection. Being a researcher myself - he disagreed with my statements that Demerol was never used as a pain medication any longer - it was ineffective. It was our only - and for me - the worst experience - in our post-surgical relationship. Bring a private nurse - nothing else matters. All I could do was deal with the pain 24/7 and make myself walk every 2 hours. I stayed in a recliner - getting in and out of bed was pure hell.

Did you have any complications from the surgery? If so, how did you deal with them?

Besides not getting adequate pain relief - I had the searing pain in my left shoulder that comes with air inflation for lap surgery. I had a post-op infection and fever for two days. My intravenous site infiltrated 4 times - causing a painful cellulitis in both forearms - this happened because staff were unable to flush the site adequately before the next antibiotic dose. There was a concern that I was leaking at the anastomosis site and had to be ultrasounded. My drains created skin erosions that took a year to heal. I ended up staying 2 extra days because of the drains.

In the weeks after you got your surgery date, how did you feel? How did you cope with any anxiety you might have felt?

There was only a month between the last medical evaluation and the surgery date. The only anxiety came when my insurance carrier denied the surgery two weeks before the date - there was an uncertainty for a week. This created anxiety about not having the surgery and the additional anxiety that my partner suddenly expressed uncertainty about the surgery. I went through considering not doing the surgery and working with them for another year to help them lose weight - but it was very stressful to consider not doing the surgery - after all that preparation.

Describe your first few weeks home from the hospital. What should people expect from this period?

Have someone there with you for a week if possible. Use a recliner - rent/borrow one if you need to - it was very painful trying to get sleep in the bed - especially with drains. Ask for some home visiting nurse visits. The one that came the next day had the surgery herself and was EXTREMELY helpful in sharing what was normal and expected and gave some good advice. It was hard for me because I was in a lot of pain for about a week. The drains made it very uncomfortable and they dug into the skin causing erosion around the drain site which resulted in severe inflammation. The drain sites took a long time to heal - and made a lot of scarring at the end that kept getting pushed in by the body fat. I started off following the recommended foods - but within a week I was vomiting all the time. I thought it was what I should expect - until I was vomiting water too - then called the surgeon and was referred to the gastroenterologist - who told me it was most likely a stricture at the end where the espophagus and new stomach were sutured together. This happened two more times over the course of the next 2 months - and eventually foods that I was able to eat the first week after surgery - like poached eggs became intolerable. Trying to drink the 64 oz of water got worse and worse - nothing tasted right - and the mouth odor - from not eating much - became disgusting for anyone around me. As much as I was obsessed with eating before the surgery - compulsive eating - I was just as obsessed after the surgery - because I HAD TO get the protein in and was having a very hard time getting my protein amounts and water amounts in - it took me almost 8 months before I was beginning to eat the kind of diet I was told I could eat at 2 months. When I saw the nutritionist - she said that happened to some people. After 2 weeks I was able to sit a my computer and found an informative site done by a bariatric surgeon who talked about his patients recovery of 20 years - that was where I learned that it takes about 5-8 months for the new stomach to heal - and that many people can't tolerate the hard proteins - and not to obsess about it - just try to get soft proteins in as much as possible - and try to get in the habit of following the rules - and getting into an exercise routine - because when the stomach does heal - his patients began to crave foods again - eat sugars again (small amts) - and had plateaus with weight loss. I wasn't having problems with weight loss - it was literally dropping off me every week - 20-25 lbs a month for 6 months. And I thought I would never crave food - especially any form of sugar - ever again - but now - a year later - I do.

How far did you travel to have your surgery? (If far, how did this affect your aftercare?)

I was close to my hospital - traveling isn't a problem - and very helpful for support meetings.

Please describe in detail what things you could and couldn't eat in the weeks and months following surgery. What foods have been off limits? Please explain how your dietary tolerance changed week-by-week, and then month-by-month since surgery.

Because of the recurring esophageal strictures I was not able to eat anything for several months. I did the liquids and soft boiled/poached eggs the first week - but ate about 1 oz before nausea set in. After 2 weeks I was supposed to advance to dry toast - but I never could tolerate any mashed protein foods. Eventually I was throwing up water as soon as I tried to drink it - and that made me think something wasn't right - which started the first endoscopy and balloon dilation. After each dilation I would try to eat the foods recommended by almost all the web sites - minced meat (turkey/chicken) and protein shakes. Any form of sugar made me violently nauseous or gave me diarrhea - even the fake sugars - I tried them all - including Splenda - I could not tolerate any taste of sweetness. I would spend a few hours in the supermarket trying to find things without sugar. It was impossible - all products have some form of sugar. Lactaid (which I drank before surgery) was intolerable so milk products were out and lactain products too. All the protein shakes also were too sweet and diabetic products had fake sweetners in them - which were equally disgusting to me. I simply did not eat - and would force myself to sip at 12 oz protein drinks all day for almost 3 months - i was exhausted all the time and my hair began to thin out after the 2nd month. Biotin products (tablet and hair products) did not work for me. After the third dilation I started to keep some liquid and soft foods down. But a year after surgery I still can't tolerate chicken, turkey, salmon, tuna, sardines, chopped liver, any sandwich (lo fat) meats, beans of any kind (uncontrollable gas), most cheeses, and all soy products. I tried protein powders, protein shakes, mixing tofu with everything I could imagine - I spent a lot of money that ended up with throwing the food out. The past two weeks I have been able to eat boiled chicken - but it feels like a lump in my chest - and sometimes I still throw up. I work long hours during the week and come home very late - between 10pm and 2am - when I get to the apt I am usually hungry now - but can't eat that late - any protein I try to eat late feels like it's stuck in my throat. I do better by eating in the mornings and afternoons. My diet after one year is - oatmeal with a banana almost every morning - I have not eaten any eggs without vomiting the while year. I eat soups for lunch - usually vegetable and beans of some kind - I try to add a little chicken - and small salads - or a baked potato with cheese on it (but still can't always tolerate the cheeses); if I come home at a reasonable time I try different fishes with a vegetable - I can tolerate scallops sometimes and I make fish stews on the weekends for the rest of the week (but get tired of those stews very quickly)- I tried filet mignon recently and that was ok - but not as tasty as I remember. I used to eat a 2 lb steak without any difficulty - haven't had any type of red meat the past year. I tried to eat a burger from three different fast food places and a sirloin burger that I made at home - felt sick after each effort. basically I mince chicken because I have to get some protein in - all other meats are still not tolerated. I try different fishes - the fatty ones are hard to eat. I tried all ways of soy products but just could not eat them - I found a health food store that makes protein shakes now (50gm in 24 oz) - but it is too sweet and half of it is still in the cup 2 days after purchase - right now. I added protein powders to my soups and drinks for a while (soy milk) but they were disgusting - I forced myself to drink them at least 3 times a week for several months - because my nutrition was so poor - but I can taste the vomit in my mouth when I even think about those drinks. A year later I am still struggling with eating without getting sick at least 3 times a week. The nutritionist says that it is extreme but not unusual and that as long as I keep trying - and my lab values don't reflect serious concerns - we should wait - some people take as long as 2 yrs to begin to eat an array of different foods. I do want to snap her skinny neck some visits :) Now - a year later - I'm craving and tolerating grapes - and can eat a cup at a sitting. Mashed potatoes are tolerable too - except that the nutritionist discourages depending on potatoes so much. usually now a salad, almost all vegetables , most fruits are easier to eat than any protein - in any form. proteins I still have to plan on how to get enough in and force myself to eat them first.

What was your actvity level in the days and weeks after surgery?

because of the drains - that stayed in for 3 weeks after surgery - I was miserable and in pain - no activity. I tried to walk a mile each day and do the exercises - most days I could go a half mile and do the exercises. After a month - I began to walk a mile a every day but was exhausted after the walk. Not eating made me debilitated and fatigued for 3 months after the surgery. I was on summer break from my job as a professor so I could take it easier and was glad for that. When I came back to work I tired by 2-3pm every day - and if I could have - I would have napped every day until 6 months after the surgery. There were times when I could not walk about the flight of stairs at the end of a work day - up til the 5th month post surgery - I had to get on my rear and slowly take them one at a time - seated. I started my cardio program 8 months after surgery and was evaluated as having little strength or endurance - now a year later I'm beginning to work at the beginning level for the program. I have more stamina and energy - but still tire by mid afternoon - and need to sleep almost 12 hrs on Friday-Saturday - with a nap on Sunday afternoon - almost all weekends.

What vitamins and/or dietary supplements have you taken since your surgery?

Multivitamins every day - Calcium, folic acid, supplements in addition to the vitamins. I started with sublingual folate but now give myself a vitamin B shot every month.

What side effects (nausea, vomiting, sleep disturbace, dumping, hair loss etc.) were worse for you? For how long after surgery did they persist? How did you cope with them?

Nausea and vomiting were constant for 3 months - then several times a week depending on what I was trying to eat. Now I get a sudden attack of dry heaves that I cannot control - especially when I'm tired - I'll be walking in the mall and suddenly begin to salivate - and have to get to a trash can or the rest room (if close enough) and will salivate about 6 oz immediately - with extreme uncontrollable dry heaves. If I work all day and come home tired - I get nauseous with anything I try to eat - including protein shakes - and sometimes throw up some of what I tried to eat. Any sugary base causes me to have severe cramps. I never had the "dumping" of sweats and rapid pulse and/or passing out. Came close to it at Passover when my hostess gave me a piece of sugar-free cake - sucrolose - I was violently sick that night. I cope with the dry heaves by finding a private area and keep a plastic bag for the saliva in my backpack - I don't have any control over it so I just let it go - as privately as I can - most of the time I can get myself to a public rest room - but when I can't I try to cover up my mouth and discretely salivate into the bag. Since I lost weight so fast - my hair began to fall out in the 3rd month. I tried biotin shampoo but it did not work. It only stopped thinning out a year later - I'm considering a wig now. Foul breath was a big problem for my partner for several months after the surgery. All of the breath products were too sweet too tolerate - including the diabetic products. Because it repelled my partner - I forced myself to suck on the breath mints - but they always caused me to be nauseous. Passing gas and not being able to control it has been embarrassing - since it happens while I am lecturing. Both my stools and the gas have a very strong odor - which is embarrasing when in public. It happens with all food groups that I tried - not just the carb foods - and I try to warn friends and family and just deal with the embarrassment when it happens near others. In public toilets and in my office I strike a match - which effectively gets rid of any odor immediately. I started getting very severe toe, balls of the foot, ankle, calf and thigh cramps - that woke me up in the night - these sometimes last as long as a half hour and nothing relieves them except waiting. it's a nutritional effect. I am now anemic and have severe fatigue related to my hemoglobin of 8 - 2 months ago my Hemoglobin was 12 - I am having a folate deficiency being worked up this week. A year after the surgery I can't tolerate many foods - mostly protein foods - have no control over passage of gas or sudden onset of dry heaves when I'm tired. Still get nauseous after the protein meals - but vomit only if it's late at night or a protein that I'm trying for the first time - or retrying - eggs still make me vomit (in any form) hair thinning has slowed a little - but what is left is very thin - my scalp is easily seen - anemia and fatigue and some nutritionally related deficinecy that result in muscle cramping. Energy is still low to moderate.

What was the worst part about the entire bariatric surgery process?

The long recovery for me - and the food intolerances. Much worse is the effect it has had on my 30 yr relationship - we have come close to divorcing 3 times since January 1st. I'm hoping that therapy will help us through this period.

What aftercare support group/program do you have? How helpful/important is this?

The surgeon has an excellent support program and expects everyone to attend. it is held monthly and there is a web site developed by one of the patients - it does not have the sanction of the surgeon. My job prevents me from attending these support meetings. Another post-op woman and I are in the same cardio fitness program and we formed our own mini-support system - which has worked well for both of us. Also I use web resources like this one.

What is your scar like? Is this what you expected?

I had the lap RNY - they look like small pock marks - can't wear a two piece without it being noticable - but the excess skin keeps me from wearing 2 pieces anyway. I expected worse - since I had problems with the drains and has severe erosion at the site of the drain - that scar is larger but healed.

Please describe any plateau experiences you have had since surgery.

this is my first plateau - I went from 290 to 130 in 9 months and then stabalized (fortuneatly) for the past 3 months. For me - the weight literally melted off my body - I skipped 2 dress sizes every month.

Do you notice people treating you any differently now?

Two different responses from those who knew me as an obese person. They either think I look like a cancer victim or they think I'm beginning to get color back and look better finally - after a year. Those who never knew me as obese - think I look like I've been slender all my life - they expected me to look like a fat person who lost weight - but keep saying they can't believe my photos from a year ago. Most dramatic changes are the professional ones. I have held some high profile jobs - and when I was obese I was often overlooked at meetings or treated with a complacent or condescending attitude. Now I attend professional meetings and some of the same people react differently - paying attention and ask for my opinion. I still have almost the same opinions - but they listen. Some consider the surgery a courageous choice - others think it was the 'easy way out" and reflects a lack of discipline (but those are fewer than the positive reactions).